ROLE OF MESALAMINE IN MAINTAINING REMISSION OF ULCERATIVE COLITIS
Main Article Content
Keywords
Ulcerative Colitis, Mesalamine, Remission, Adherence, Long-term Safety, Therapy Efficacy.
Abstract
Background: The colonic mucosa becomes inflamed when someone has ulcerative colitis (UC), a chronic inflammatory bowel disease. In order to enhance quality of life and minimize problems, managing UC focuses on achieving and sustaining remission.
Objective: The study objective was to evaluate mesalamine's role in maintaining UC remission, focusing on optimal dosing, formulation efficacy, long-term safety, and the impact of patient adherence.
Methodology: This prospective trial included 390 participants with ulcerative colitis and ran from January to December 2023 at SIMS, Services Hospital, Lahore. Clinical and demographic data were gathered, and mesalamine treatment was customized for each patient. Regular follow-ups used patient self-reports, pill counts, and pharmacy refill data to track adverse events, treatment adherence, and disease activity. Study population was summed up using descriptive statistics. Continuous variables include median with interquartile range or mean ± standard deviation. Regression modeling and inferential analysis evaluated the relationship between mesalamine treatment and UC remission while controlling for variables.
Results: The average age of the 390 ulcerative colitis patients in this research was 42.5 ± 12.3 years, with 177 females (45.38%) and 213 men (54.62%). The patients' levels of severity are as follows: light (116, or 29.74%), moderate (193, or 49.49%), and severe (81, or 20.77%). 311 individuals (79.74%) were in remission after a year. Headaches: 21 patients (5.38%), nausea: 13 patients (3.33%), and stomach pain: 9 patients (2.31%) are the adverse effects. Moderate UC severity (p < 0.001) and adherence (p < 0.001) were substantially linked with remission. Low rates of hepatotoxicity (5 individuals, 1.28%) and renal impairment (7 patients, 1.79%) indicate long-term safety.
Conclusion: Medication compliance and disease severity control are crucial because mesalamine successfully sustains remission in ulcerative colitis, reaching a 79.74% remission rate at 12 months with little side effects.
References
2. Gajendran M, Loganathan P, Jimenez G, Catinella AP, Ng N, Umapathy C, Ziade N, Hashash JG. A comprehensive review and update on ulcerative colitis. Disease-a-month. 2019 Dec 1;65(12):100851.
3. Guo XY, Liu XJ, Hao JY. Gut microbiota in ulcerative colitis: insights on pathogenesis and treatment. Journal of digestive diseases. 2020 Mar;21(3):147-59.
4. Cardozo WS, Sobrado CW. Clinical manifestations in inflammatory bowel disease. InInflammatory Bowel Disease 2022 Sep 1 (pp. 81-100). River Publishers.
5. Armuzzi A, Liguori G. Quality of life in patients with moderate to severe ulcerative colitis and the impact of treatment: a narrative review. Digestive and Liver Disease. 2021 Jul 1;53(7):803-8.
6. Mikami Y, Tsunoda J, Suzuki S, Mizushima I, Kiyohara H, Kanai T. Significance of 5-aminosalicylic acid intolerance in the clinical management of ulcerative colitis. Digestion. 2023 Jan 3;104(1):58-65.
7. Słoka J, Madej M, Strzalka-Mrozik B. Molecular mechanisms of the antitumor effects of mesalazine and its preventive potential in colorectal cancer. Molecules. 2023 Jun 29;28(13):5081.
8. McCoubrey LE, Favaron A, Awad A, Orlu M, Gaisford S, Basit AW. Colonic drug delivery: Formulating the next generation of colon-targeted therapeutics. Journal of Controlled Release. 2023 Jan 1;353:1107-26.
9. Selvamani S, Mehta V, El Enshasy HA, Thevarajoo S, El Adawi H, Zeini I, Pham K, Varzakas T, Abomoelak B. Efficacy of probiotics-based interventions as therapy for inflammatory bowel disease: a recent update. Saudi journal of biological sciences. 2022 May 1;29(5):3546-67.
10. Yarlas A, D’Haens G, Willian MK, Teynor M. Health-related quality of life and work-related outcomes for patients with mild-to-moderate ulcerative colitis and remission status following short-term and long-term treatment with multimatrix mesalamine: a prospective, open-label study. Inflammatory bowel diseases. 2018 Jan 18;24(2):450-63.
11. Tripathi K, Feuerstein JD. New developments in ulcerative colitis: latest evidence on management, treatment, and maintenance. Drugs in context. 2019;8.
12. D’Amico F, Fasulo E, Jairath V, Paridaens K, Peyrin-Biroulet L, Danese S. Management and treatment optimization of patients with mild to moderate ulcerative colitis. Expert Review of Clinical Immunology. 2024 Mar 3;20(3):277-90.
13. Paridaens K, Fullarton JR, Travis SP. Efficacy and safety of oral Pentasa (prolonged-release mesalazine) in mild-to-moderate ulcerative colitis: a systematic review and meta-analysis. Current Medical Research and Opinion. 2021 Nov 2;37(11):1891-900.
14. Jess T, Rungoe C, Peyrin–Biroulet L. Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clinical gastroenterology and hepatology. 2012 Jun 1;10(6):639-45.
15. Böhm SK, Kruis W. Long-term efficacy and safety of once-daily mesalazine granules for the treatment of active ulcerative colitis. Clinical and experimental gastroenterology. 2014 Sep 23:369-83.
16. D'Amico F, Lusetti F, Peyrin-Biroulet L, Danese S. MMX mesalamine in ulcerative colitis: Major advantages towards classical mesalamine formulations. Digestive and Liver Disease. 2024 May 4.
17. Khan N, Abbas AM, Koleva YN, Bazzano LA. Long-term mesalamine maintenance in ulcerative colitis: which is more important? Adherence or daily dose. Inflammatory Bowel Diseases. 2013 May 1;19(6):1123-9.
18. Ham M, Moss AC. Mesalamine in the treatment and maintenance of remission of ulcerative colitis. Expert review of clinical pharmacology. 2012 Mar 1;5(2):113-23.
19. Lichtenstein GR, Gordon GL, Zakko S, Murthy U, Sedghi S, Pruitt R, Merchant K, Shaw A, Bortey E, Forbes WP. Clinical trial: once‐daily mesalamine granules for maintenance of remission of ulcerative colitis–a 6‐month placebo‐controlled trial. Alimentary pharmacology & therapeutics. 2010 Oct;32(8):990-9.
20. Zakko SF, Gordon GL, Murthy U, Sedghi S, Pruitt R, Barrett AC, Bortey E, Paterson C, Forbes WP, Lichtenstein GR. Once-daily mesalamine granules for maintaining remission of ulcerative colitis: pooled analysis of efficacy, safety, and prognostic factors. Postgraduate Medicine. 2016 Apr 2;128(3):273-81.
21. Solitano V, D’Amico F, Fiorino G, Paridaens K, Peyrin-Biroulet L, Danese S. Key strategies to optimize outcomes in mild-to-moderate ulcerative colitis. Journal of Clinical Medicine. 2020 Sep 8;9(9):2905.
22. Troncone E, Monteleone G. The safety of non-biological treatments in ulcerative colitis. Expert Opinion on Drug Safety. 2017 Jul 3;16(7):779-89.
23. Adiga A, Goldfarb DS. The association of mesalamine with kidney disease. Advances in chronic kidney disease. 2020 Jan 1;27(1):72-6.
24. Sehgal P, Colombel JF, Aboubakr A, Narula N. Systematic review: safety of mesalazine in ulcerative colitis. Alimentary pharmacology & therapeutics. 2018 Jun;47(12):1597-609.